When a hospital releases a patient, the family is usually not prepared to take over the care responsibilities. The medical stay could be the result of an accident or fall. When that happens, there is little time to plan ahead. A loved one’s care consumes the attention, and thoughts about the discharge are not a priority. An error everyone makes, until the case manager declares, “It’s time to leave.”
But the patient can’t go home because she needs rehab to recoup and the discharge nurse explains, “Even though the patient needs extra help and rehab, Medicare won’t cover that expense.”
It’s the third-day rule. For Medicare to cover skilled nursing care and rehab after a hospital visit, the patient must meet the three-day-stay regulation, meaning the person must receive hospital care for three days and three nights. But your loved one stayed three days and only two nights.
Now the scramble begins. Not only are they left with locating a quality post-acute care or a rehab center, but they also have to figure out how to pay for it. (Hopefully, the patient has a Medicare insurance supplement. If not, check with Medicaid to see if one qualifies.)
Since the launch of the Accountable Care Act, a means to reduce health care costs by encouraging doctors, hospitals and other health care providers to form networks to coordinate care, the networks are eligible for bonuses when the care is efficient. Therefore, the doctors and hospitals share financial and medical responsibility for coordinated care to patients in hopes of limiting unnecessary spending.
The nursing homes and assisted living facilities are part of the coordinated care network and deliver short-term post-acute care.
Skilled Nursing homes give medical care on an extended, and now, temporary basis since reform. They expand staff to attending physicians, medical specialists, rehab therapists, registered and licensed nurses, social workers, nursing assistants, and others that resemble the kind you find in a hospital setting.
The facilities give post-stroke recovery, pulmonary care, wound care, hip fracture and replacement, knee or other joint replacement, cardiac or respiratory support, tracheostomy weaning, nutritional therapy, and dementia care.
Assisted living residences followed suit and provide short-term rehab treatments and recuperative maintenance.
Hospitals refer patients with fewer needs to assisted living homes. When transitioning from the hospital, the staff helps the patient prepare and fully recover for the return home.
Other deliveries of care include incontinence improvement, fall management, orthopedic fracture recovery, pain management, patient/family training and education, nursing observation, wound care and skin management, physical, speech, and occupational rehab and much more.
Post-acute care providers promote self-reliance and return patients home quickly. Hiring or partnering with physicians, nurses and therapists help deliver the highest quality care and help patients attain their highest level of independence.
Carol Marak, aging advocate, columnist, and editor at SeniorCare.com. She earned a Certificate in the Fundamentals of Gerontology from the University of CA, Davis.